The Influence of Exercise Workload Progression Across 36 Sessions of Cardiac Rehabilitation on Functional Capacity

Abstract

Defining time frames throughout cardiac rehabilitation (CR) to progress exercise workloads may lead to improve functional capacity outcomes. The purpose of this study was to investigate the role of exercise progression on functional capacity among cardiac patients enrolled in CR. This was a retrospective database analysis study. Extracted data included: Demographic, functional capacity (in METs), and exercise intensity during exercise sessions 2, 12, 24, and 36 of CR from 150 patients who completed a 36-session program. Progression of exercise was determined by calculating percent change in treadmill exercise workload within predefined time frames of CR. The time frames were percent change from exercise session 2 to 12 (“%ΔS2–S12), 12 to 24 (%ΔS12–S24), and 24 to 36 (%ΔS24–S36). A multiple linear regression model was developed to predict change in functional capacity (ΔMETs). A significant proportion (21%) of total variation in ΔMETs was predicted by %ΔS2–12, %ΔS12–24, %ΔS24–36, age, sex, and body mass index (BMI). Percent changes between sessions 12 to 24 (%ΔS12–24; β = 0.17, p = 0.03) and 24 to 36 (%ΔS24–36; β = 0.23, p < 0.01) were significant predictors. Progressing patients between sessions 12 to 24 and 24 to 36 predicted significant changes in functional capacity and reinforced the importance of exercise progression across all 36 sessions of CR.

Cardio-oncology rehabilitation: are we ready?

“…The CORE training session should last at least 60 min (warm-up, plateau, and cool-down), at least three times a week, including aerobic and resistance exercises 50 and prescribing an exercise intensity using the usual CR methods (from indirect ones, based on a scale of subjective perception of fatigue to direct ones based on the calculation of training heart rates through physical exercise or cardiopulmonary tests). 51 Generally, a gradual approach with a progressive increase in workload is preferred, especially in patients with metastases, osteoporosis, or recent surgical interventions. The protocol should last for at least 24 sessions, but in subjects with compromised contractile function, it is reasonable to reach 36 sessions in total.…”

“…Moreover, it is known, at least for the CR, that the improvement in functional capacity is progressive and constant with the increase in the number of sessions at least until the 36th session. 51 …”

Exercise Prescription Guidelines for Cardiovascular Disease Patients in the Absence of a Baseline Stress Test

“…In addition, coronary artery disease patients, who exercise at or below 3.5 METs upon completion of CR were characterized as a high-risk group with 3-year cardiac event rates above 18% [23]. Furthermore, our group recently reported that an increase in treadmill exercise workloads between CR sessions 12 to 24 and 24 to 36 predicted functional capacity improvements of 0.50 to 0.80 METs, respectively in a diverse group of patients [24]. Collectively this suggests it is of critical importance that CVD patients are progressed toward achieving higher exercise workloads throughout their CR program.…”